Psych: Dissociative Disorders: Free MSRA Podcast

⚕️ FREE MSRA PODCAST – Dissociative Disorders
🎧 A full breakdown of Dissociative Disorders, including dissociative identity disorder (DID), depersonalisation, and dissociative amnesia – tailored for high-yield MSRA revision.

🧠 Key Learning Points

📌 Definition
• Dissociative disorders are a group of mental health conditions characterised by disruption in consciousness, memory, identity, or perception.
• These disorders often arise in the context of severe psychological trauma, especially in childhood.
• The spectrum includes:

• Dissociative Identity Disorder (DID)

• Dissociative amnesia

• Depersonalisation/derealisation disorder

📌 Etiology
• Primary trigger: Psychological trauma, particularly chronic abuse or neglect in early childhood
• Protective mechanisms: Dissociation acts as a survival strategy to escape unbearable situations
• Other contributors:

• Lack of supportive relationships

• Pre-existing mental illness or personality traits

• Neurobiological vulnerability

📌 Pathophysiology
• Disrupted processing of memory, attention, and perception
• HPA axis dysregulation and altered stress response
• Result: Fragmentation of conscious experience and identity

📌 Clinical Features
• Memory gaps for personal or traumatic events
• Depersonalisation – feeling disconnected from one’s body or thoughts
• Derealisation – surroundings feel unreal or foggy
• DID – presence of two or more distinct identity states with associated amnesia
• Triggering events: Stress or trauma reminders can worsen symptoms

📌 Differential Diagnosis
• PTSD
• Borderline Personality Disorder (BPD)
• Somatic Symptom Disorder
• Schizophrenia (due to misinterpreted internal experiences)
• Malingering or factitious disorder (intentional feigning)

📌 Epidemiology
• Precise prevalence is unclear due to underdiagnosis
• DID estimates range from 0.1% to 1%
• Notes stress scepticism among clinicians as a barrier to recognition

📌 Diagnosis & Assessment
• Requires detailed psychiatric assessment
• Use of structured tools:

• Dissociative Experiences Scale (DES)

• SCID-D (Structured Clinical Interview for DSM Dissociative Disorders)

• SDQ-20 (Somatoform Dissociation Questionnaire)
  • Diagnosis must exclude neurological or medical causes

📌 Management
• Multidisciplinary approach
• Core treatment = trauma-focused psychotherapy

• CBT, DBT, EMDR

• Sensorimotor psychotherapy
  • DID: Requires long-term relational therapy, often 5+ years
  • Phase-oriented model:

1. Safety & stabilisation

2. Trauma processing

3. Integration of self-states
   • Pharmacotherapy used only for comorbid symptoms (e.g., anxiety, depression)
   • Emphasis on therapeutic alliance and trust-building

📌 Prognosis
• Varies by severity, trauma history, and access to care
• Many improve with early, specialised, consistent therapy
• Described as a

Episode Transcript

(00:00):
Welcome to the Deep dive. Today we're tackling well a
really complex and often misunderstood topic,
dissociative disorders. And this deep dive is actually
shaved by you specifically from the revision notes you've
gathered, possibly for somethinglike the MSRA.
That's right. Our goal here is to, you know,

(00:20):
work through that material together.
Yeah, pull out the high yield stuff.
Make it clear, Make it stick whether you're deep in revision
or just aiming to get properly informed.
Exactly. We'll look at the definitions,
causes, symptoms, diagnosis, treatment, the whole picture
presented in these notes. OK, brilliant.
Let's just dive straight in then.
According to these notes, what exactly are we talking about

(00:41):
with dissociative disorders? So fundamentally, there are a
group of mental health conditions where there's some
kind of breakdown or disruption in the normal integration of
consciousness, memory, identity,even perception.
A disruption like things that should be connected aren't.
Precisely. It often results from
significant trauma or stress, causing a sort of detachment.

(01:01):
The notes highlight that this exists on a spectrum, so you
might see, say, milder dissociation in something like
PTSD all the way up to the more severe end like dissociative
identity disorder, DID and. The notes gave other specific
examples too, right? Yes, dissociative amnesia, where
memory loss is the main feature,and depersonalization,

(01:23):
derealization disorder, that's about feeling detached either
from yourself or from the world around you, feeling unreal.
And across the board, these notes point to things like
memory problems that don't quitematch the emotions tied to them,
a kind of fragmented sense of self.
And specifically with DID, thosedistinct personality States and

(01:44):
significant memory gaps, Right. A really key point the notes
make those that these conditionsare often hidden.
There's shame, maybe fear. So how they actually look and
vary wildly the concealment seems crucial.
Yeah, that hidden aspect makes understanding and diagnosis is
really challenging, doesn't it? Absolutely.
So if trauma is often the trigger, let's talk aetiology,
the why. Why does trauma lead to this

(02:05):
sort of disconnection for some people?
Well, the notes are pretty direct here.
They point primarily to significant psychological
trauma, especially when it happens during childhood, those
critical developmental years. OK, the thinking is the trauma
is just too overwhelming for theperson's normal coping
mechanisms, so dissociation kindof kicks in automatically.

(02:27):
It's a way to mentally escape something unbearable.
A survival strategy, essentially, when you can't
physically get away. Exactly.
It's a coping mechanism born outof necessity.
But the notes also add, it's notjust the trauma.
Yeah, things like inherent personality factors or maybe
some neurobiological vulnerabilities might make

(02:47):
someone more likely to go down that dissociative route when
faced with trauma. Right.
So it's a mix of the external event and maybe internal
predispositions that makes. So who's most at risk then?
What are the key risk factors listed in the notes?
OK, the notes layout several important ones.
First, severe childhood trauma or neglect.
That's a big one. Then repeated traumatic
experiences, not just a single event.

(03:08):
Also, trauma starting at a very young age seems particularly
impactful. Early onset, yes.
And critically, a lack of a supportive social network, not
having that buffered during or after.
That makes a huge difference. It really does.
And finally, the notes mention individual factors again,
certain personality traits, a history of other mental health

(03:29):
issues, or even a family historyof dissociative disorders.
Wow. It really highlights the
profound impact of early life experiences and, well, the
environment, doesn't it? It absolutely does.
It underscores how vital that safety and support really are
for development. OK, so moving from the why to
maybe the how, the pathophysiology, what do the

(03:51):
notes suggest is actually happening biologically in the
brain or body? Well, the notes talk about
disruptions and how the brain processes information, so things
like memory, attention, perception, and just integrating
conscious experience aren't working smoothly.
When trauma occurs, it activatesthe body's stress response
systems. The notes mention the HPA axis

(04:12):
and neurotransmitters. Right, the stress hormones and
chemicals. Exactly.
And it's thought that these neurobiological changes, this
kind of stress OverDrive, contributes directly to that
fragmentation of consciousness and memory that we see in these
disorders. So the biological stress
response itself plays a part in the dissociation.
That seems to be the link the notes are making.

(04:32):
Yeah. Which brings up the question,
how do these biological changes actually show up?
What does it look like for the person experiencing it?
Yeah, the. Clinical features What are the
common symptoms described in thenotes?
There are several key ones listed.
Recurrent memory gaps, often forreally important personal
details or traumatic events. That's the amnesia part.
Then there's identity confusion or even the presence of distinct

(04:55):
separate identity states, which is the hallmark of DID right.
Also persistent feelings of detachment.
That could be feeling detached from your own body, thoughts or
feelings like depersonalization,or feeling like the world around
you is unreal or foggy derealization.
OK, so detachment from self or surroundings?
Yes, and the notes give exampleslike difficulty recalling things

(05:17):
that happened, feeling like you're watching yourself from
outside your body, or just feeling disconnected from your
own physical sensations. There can also be noticeable
shifts in behaviour, mood or self perception.
And importantly, stress or trauma reminders can often
trigger or worsen these symptoms.
Some of those descriptions, likewatching yourself from outside,

(05:39):
sound incredibly disorienting. I can definitely see why
diagnosis would be tricky, givenhow well unusual some of these
might seem. It is very challenging and that
leads right into the differential diagnosis section
in the notes. What else could it be mistaken
for? Good point.
What does it list? The notes mentioned PTSD,
borderline personality disorder,BPD, somatic symptom disorder

(06:01):
and they also list malingering and fictitious disorder where
illness is intentionally feigned.
OK, so a range of things. Yes, but the notes specifically
call out the difficulty with DID.
It's apparently often misdiagnosed as schizophrenia,
other psychotic disorders, mood disorders like depression or
bipolar, substance abuse issues,or very commonly other
personality disorders, especially BPD.

(06:23):
Why the confusion, particularly with things like schizophrenia
or BPD? Is it overlapping symptoms?
It seems so. Perhaps the identity confusion
or maybe internal experiences that get described like voices,
which might be internal dialoguebetween parts and DID, or the
feelings of unreality could, youknow, superficially resemble
psychotic symptoms or the instability seen in BPD.

(06:45):
The notes really stress this misdiagnosis issue for DID.
It really underscores the need for specialised assessment,
doesn't it? Absolutely.
Which brings us to epidemiology.How common are these conditions,
according to the notes, particularly in the UK?
Right what they say. Well, interestingly, the notes
state the overall prevalence isn't well established.
They suggest this is partly due to under diagnosis.

(07:08):
Linking back to the diagnostic challenges.
Exactly. If or did specifically though,
they give a prevalence range between .1% and 1%, but the
source finishes by saying quite clearly further research needed.
So still quite a bit of uncertainty there.
Definitely seems that way. OK, here's where it gets really
interesting for me. If diagnosis is tough but there

(07:29):
are tools, why is the prevalencestill so unclear?
And why the continued misdiagnosis, especially for
deed? That's the $1,000,000 question,
isn't it? The notes do outline a pretty
thorough investigation process. It should be done by mental
health professionals involving detailed histories, psychiatric
interviews, psychological assessments.

(07:49):
They also mentioned collaborating with other doctors
to rule out medical or neurological causes for things
like memory loss. So it should be comprehensive.
Are there specific tools mentioned for assessment?
Yes, the notes list some standardised questionnaires and
interviews. Examples given are the DSM
Dissociative Experiences Scale, the SDQ 20 somatoform
Dissociation questionnaire, and the SCIDD Structured Clinical

(08:11):
Interview for DSM Dissociative Disorders.
OK, so there are structured waysto assess?
There are. But, and this is crucial, the
notes heavily emphasised the need for trust.
Creating a safe space is paramount because people won't
share these often frightening orconfusing experiences otherwise.
Makes sense. But even with these tools and
approaches, the notes repeat that many people with DD still

(08:35):
don't get the right diagnosis, and the reason given is
scepticism among some clinicians.
Scepticism. Wow.
So that's a major hurdle identified in the source
material itself. It appears so, a need for more
awareness and maybe acceptance within the field.
That's a really significant point from these notes.
So, OK, assuming a correct diagnosis is made, how are these

(08:55):
conditions manage? What's the treatment approach
outlined? It's described as
multidisciplinary, so usually psychotherapy is the main thing,
but sometimes medication might be used for specific symptoms
like anxiety or depression. Importantly, not for the
dissociation itself and wider support systems are key to.
And the core therapy? Trauma focused therapy is
highlighted as primary. The notes mentioned TF, CBT,

(09:17):
Trauma Focused Cognitive behavioural therapy and EMDR Eye
movement desensitisation and reprocessing as examples.
So really getting at the root trauma.
That seems to be central. The goals listed are about
improving symptoms, processing the trauma, building better
coping skills, and integrating those fragmented parts of
experience and memory. Social support and community

(09:39):
resources are also mentioned as important parts of the plan.
OK. And.
What about DD specifically? The notes seem to go into more
detail there. They did.
It's described as needing long term psychotherapy, often 1 to 1
relational therapy, maybe weekly, potentially for five
years or even longer. Wow, that's a serious
commitment. It really is.
The therapy isn't just one single type.
It draws on various techniques. CBPDBT, EMDR, sensor, motor

(10:02):
approaches are all mentioned. A key framework discussed is
phase oriented treatment. Phase oriented?
How does that work? Typically 3 stages.
First, focusing on safety, stability and building coping
skills. You need a solid foundation.
Second, carefully working through and processing the
traumatic memories. And 3rd, the integration phase,
bringing the different parts of the self together more

(10:25):
cohesively and helping the person function better in daily
life. Addressing things like
disorganised attachment patternsfrom childhood is also part of
it. That sounds incredibly intensive
for both the person in therapy and the therapist.
No doubt the notes mention specific challenges for
therapists, complex emotional dynamics like transference and
countertransference, and managing boundaries carefully.

(10:48):
And they make a really importantpoint.
The quality of the relationship between the therapist and the
client is a huge predictor of success.
The therapeutic alliance. Exactly, and a big part of the
work involves engaging with the older personalities.
How is that approached? The notes describe it as
understanding these different states, helping them communicate
and cooperate, potentially moving towards integration.

(11:11):
They mentioned structural dissociation theory, this idea
of apparently normal personalities.
AM PS handling daily life and emotional personalities.
EPS Yeah, the trauma. The approach suggested is non
judgmental affirmative engagement with these parts.
The ultimate aim. Integration isn't about getting
rid of parts, but helping the disconnected emotions, memories,

(11:33):
behaviours and identity fragments become more connected,
more whole. It's described as yes, long
demanding work, but potentially very rewarding.
That's a really thorough explanation of the complex
process. What about the prognosis then?
What's the likely outlook based on these notes?
Well, the notes say it varies depends on how severe the

(11:54):
disorder is, the trauma history,if there are other conditions
present and of course, how effective the treatment is.
So no single answer. Not really, but the notes are
quite positive overall. They state that many people can
experience significant improvement in their symptoms
and and daily functioning with the right kind of comprehensive
help. It's seen as a gradual ongoing
recovery process, not an overnight cure.

(12:16):
OK. And getting help early with
specialised treatment really boosts the chances of a better
long term outcome. That's encouraging.
And on the flip side, what are the risks if these conditions
aren't treated? What complications do the notes
mention? The notes list quite a few
potential problems. Things like major difficulties

(12:36):
in social life and work relationships can be really
disrupted. There's a higher risk of other
mental health issues developing,like depression or anxiety
disorders. Self harm and substance abuse
are also noted as significant risks.
Serious consequences. Yes, and ongoing problems with
memory and concentration can really impact daily life.
Just basic functioning, maintaining stable

(12:57):
relationships, holding a job allbecome much harder.
The notes really hammer home that early recognition and
proper management are crucial toprevent or lessen these
complications. Wow.
OK. So we've really covered the
ground laid out in these notes for the basic definition, the
trauma connection, the specific symptoms, the challenges around
diagnosis. Right through to the intensive

(13:18):
treatment, especially for DAD and the outlook.
It's clear these are complex, serious conditions, often rooted
in really difficult experiences needing specialised care.
But importantly, the notes do suggest that recovery and
improvement are definitely possible with the right support.
Absolutely. And reflecting on it, that point
about under diagnosis potentially due to scepticism,

(13:40):
combined with how complex the treatment is, it really makes
you wonder, doesn't it? Wonder what?
Well, given how hard these conditions can be to spot and
how often they might be missed, what impact could greater public
and professional awareness really reducing the stigma
around trauma and dissociation have on people getting the help
they need much earlier? That's a powerful thought to

(14:01):
leave people with, and it ties right back into why
understanding the kind of information of these notes is so
important. Exactly, these notes seem like a
really solid foundation, especially if you are revising
for something like the MSRA. Definitely, and for anyone doing
that kind of revision, resourcesspecifically designed for it can
be invaluable. Sites like passthemsra.com.
And free messra.com could be really useful for practise

(14:23):
questions and solidifying this kind of knowledge.
Worth checking out. Well, that brings us to the end
of this deep dive based on your notes on dissociative disorders.
We really hope working through it this way has helped clarify
things for you. Yeah, hope it was helpful.
Thanks so much for joining us.